Ostomy Management

Mary R Brennan, RN, MBA, CWON

Inquisitive nurses have questioned the status quo and challenged the current standards available at the time. They believed there was an improvement that could be made, and so these nurses began the process of validating their concerns or questions. Was this easy? Probably not, but their conviction to seek out a better method drove them to look, investigate, and validate their work. I would like to share a few stories of nurses who have changed our practice and hopefully inspire you to ask the question: Why are we doing this?

Holly Hovan MSN, GERO-BC, APRN, CWOCN-AP

Peristomal pyoderma gangrenosum (PPG) is a somewhat uncommon and challenging condition to diagnose and treat, as no evidence-based guidelines or standard treatments exist. PPG can occur after the surgical placement of an ostomy, impacting approximately 0.5 to 1.5 people per million annually, and accounts for 15% of pyoderma gangrenosum cases. Effective management of PPG requires local and often systemic immunosuppression and topical wound care, which is compatible with being applied beneath an ostomy pouch.

By: Dianne Rudolph, DNP, GNP-BC, CWOCN

What are some ways to achieve insurance coverage for fistula pouches or to use ostomy supplies for a fistula? We often run into the issue of supplies not being covered for Medicare or Medicaid patients.

Unfortunately, coverage is inadequate. CMS (Centers for Medicare & Medicaid Services) coverage for fistulas is limited for fistulas caused by or resulting from a surgical procedure, and even then, it may be difficult to get reimbursed. Spontaneous fistulas (15% to 25%) are generally not covered. The Wound, Ostomy and Continence Society is working on trying to effect a change in coverage. Some insurance companies may be more amenable to reimbursement, and it may require a case-by-case application or appeal. For patients being discharged home, it may be possible to secure a short-term supply of 10 to 14 days. The cost for the pouches may run $255 and up for a box of 10.

By Holly M. Hovan, MSN, RN-BC, APRN, CWOCN-AP

A new ostomy can be intimidating and life-changing, but also lifesaving. Many people experience a new degree of independence after ostomy surgery and often become advocates and support people for other people with ostomies. However, the initial post-operative period can be scary. People with new ostomies often have questions and concerns, and they make some lifestyle changes as well. In this blog, I will be discussing some of the most common questions I receive from people with new ostomies as a WOC nurse specialist. I will also be sharing some tips and tricks that people with new ostomies have shared with me throughout my years in WOC nursing. Review the questions and answers provided here so you will be prepared to answer your patients’ questions and help them adjust to their new lifestyle.

Holly Hovan MSN, RN-BC, APRN, ACNS-BC, CWOCN-AP

As you may have already heard, the World Health Organization (WHO) has designated 2020 as the year of the nurse and midwife. The WHO has informed us that in order to achieve universal health coverage by 2030, we need 9 million more nurses and midwives! This is a huge number. Just think, if 9 million more nurses and midwives are needed, how many more wound, ostomy, and continence (WOC) specialists are going to be needed?

By Holly M. Hovan, MSN, RN-BC, APRN, CWOCN-AP

As someone who holds tricertification, I often feel as though my ostomy patients are the ones in whose lives I am making the biggest difference. Watching them progress, gain confidence in independent ostomy management, and enjoy their lives once again is one of the best feelings to me!

Ivy Razmus, RN, PhD, CWOCN

Moisture-associated dermatitis has been described as "inflammation and erosion of the skin due to prolonged exposure to moisture and its contents which include urine, stool, perspiration, wound exudate, mucus, or saliva." Incontinence dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations. Indeed, diaper dermatitis has been used to describe an infant's skin breakdown related to moisture exposure.

by Holly Hovan MSN, RN-BC, APRN, ACNS-BC, CWOCN-AP

As discussed in a prior blog, stoma location is certainly one of the key factors in successful ostomy management and independence with care at home. However, even with proper stoma siting, peristomal skin complications may occur for a variety of reasons. In this blog I discuss a few of the more common peristomal skin complications and tips for management.

By Fabiola Jimenez, RN, ACNS-BC, CWOCN

I recently celebrated 30 years in nursing and completed my fourth year as a certified wound, ostomy and continence nurse. Since I took my current position in November of 2014, I have conducted Annual Skin Care Skin Fairs, usually in the fall. In the spring, to coincide with Nurses' Week, I join the hospital nursing educator and host the mandatory equipment fair where the staff is required to put hands on the various equipment we use in patient care. Twice a month during nursing orientation I present the products used for skin care, basics of wound care, and ostomy care. The staff is encouraged to return during subsequent months during new staff orientation and reinforce skills with which they do not feel comfortable.

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

My current job as wound coordinator has pulled me into the world of incontinence and the many disciplines that care for people challenged by this disorder. I was previously acquainted with the therapy side as I worked with therapists certified in pelvic floor therapy. My work with venous edema acquainted me with medications that caused continence-challenged people to resort to absorbent adult briefs. As I work more closely with physicians, I am more familiar with medications to support weakened or sensitive pelvic muscles and nerves. On the nursing side, I have researched support surfaces, incontinence pads, and barrier creams. I see patients and occupational therapists working together to regain continence independence through problem-solving mobility issues.